Provider Demographics
NPI:1982862488
Name:VEIN LASER CENTER, LLC
Entity Type:Organization
Organization Name:VEIN LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-659-0536
Mailing Address - Street 1:550 SUMMIT AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2700
Mailing Address - Country:US
Mailing Address - Phone:201-659-0536
Mailing Address - Fax:
Practice Address - Street 1:550 SUMMIT AVE STE 203
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2700
Practice Address - Country:US
Practice Address - Phone:201-659-0536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03767500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty